Stacking requires understanding how different compounds interact and adjusting protocols accordingly
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Following administration of a combined oral contraceptive (0.035 mg ethinyl estradiol and 0.25 mg norgestimate) in the presence of a single dose of tirzepatide 5 mg, mean Cmax of ethinyl estradiol, norgestimate, and norelgestromin was reduced by 59%,66%, and 55%, while mean AUC was reduced by 20%, 21%, and 23%, respectively
The patients at highest risk were those on higher doses, those with pre-existing borderline B12 levels, those with a history of metformin use (which independently depletes B12), and those over age 60